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Five neonates with esophageal atresia and absence of gas on abdominal radiographs were each found to have an apparently obliterated distal tracheoesophageal fistula without a long gap between the esophageal ends. Four were treated by primary repair of the esophagus, and one underwent esophageal replacement, although it is conceivable that primary repair could have been achieved if the correct diagnosis had been made at presentation. This variant of tracheoesophageal fistula can be expected in at least 14% of patients presenting with a gasless abdomen.
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